Longitudinal Weight Change During CKD Progression and Its Association With Subsequent Mortality.

Abstract

BACKGROUND:

Few studies have investigated the changes in weight that may occur over time among adults with the progression of chronic kidney disease (CKD). Whether such weight changes are independently associated with death after the onset of end-stage renal disease has also not been rigorously examined.

STUDY DESIGN:

Prospective cohort study.

SETTING & PARTICIPANTS:

We studied 3,933 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study, a longitudinal cohort of patients with CKD. We also performed similar analyses among 1,067 participants of the African American Study of Kidney Disease and Hypertension (AASK).

PREDICTORS:

Estimated glomerular filtration rate (eGFR) and weight change during CKD.

OUTCOME:

Weight and all-cause mortality after dialysis therapy initiation.

RESULTS:

During a median follow-up of 5.7 years in CRIC, weight change was not linear. Weight was stable until cystatin C-based eGFR (eGFRcys) decreased to <35mL/min/1.73m2; thereafter, weight declined at a mean rate of 1.45 kg (95% CI, 1.19-1.70) for every 10 mL/min/1.73m2 decline in eGFRcys. Among the 770 CRIC participants who began hemodialysis or peritoneal dialysis therapy during follow-up, a >5% annualized weight loss after eGFR decreased to <35mL/min/1.73m2 was associated with a 54% higher risk for death after dialysis therapy initiation (95% CI, 1.17-2.03) compared with those with more stable weight (annualized weight changes within 5% of baseline) in adjusted analysis. Similar findings were observed in the AASK.

LIMITATIONS:

Inclusion of research participants only; inability to distinguish intentional versus unintentional weight loss.

CONCLUSIONS:

Significant weight loss began relatively early during the course of CKD and was associated with a substantially higher risk for death after dialysis therapy initiation. Further studies are needed to determine whether interventions to optimize weight and nutritional status before the initiation of dialysis therapy will improve outcomes after end-stage renal disease.

• Authors: Elaine Ku, Joel D Kopple, Kirsten L Johansen, Charles E McCulloch, Alan S Go, Dawei Xie, Feng Lin, L Lee Hamm, Jiang He, John W Kusek, Sankar D Navaneethan, Ana C Ricardo, Hernan Rincon-Choles, Miroslaw Smogorzewski, Chi-Yuan Hsu, CRIC Study Investigators
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 71 Issue 5 Pg. 657-665 (05 2018) ISSN: 1523-6838 [Electronic] United States
• PMID: 29217305 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Body Mass Index
• Body Weight (physiology)
• Cause of Death
• Cohort Studies
• Disease Progression
• Female
• Follow-Up Studies
• Humans
• Kidney Failure, Chronic (mortality, physiopathology, therapy)
• Longitudinal Studies
• Male
• Middle Aged
• Proportional Hazards Models
• Prospective Studies
• Renal Dialysis (methods, mortality)
• Renal Insufficiency, Chronic (mortality, physiopathology)
• Risk Assessment
• Survival Rate
• Weight Loss (physiology)